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NPI Code Detail

MEDICARE: JOHN REESE GRAUE II D.D.S.

MEDICARE:   JOHN REESE GRAUE II D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry2008014151MO

General Provider Information

NPI Number : 1033379581
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN REESE GRAUE II D.D.S.
Provider Business Mailing Address
First Line : 1914 WHITE TAIL LN
Second Line :
City : LIBERTY
State : MO
Zip : 64068-2589
Country : US
Telephone Number : 816-809-6154
Fax Number :
Provider Business Practice Location Address
First Line : 6301 N OAK TRFY STE 202
Second Line :
City : GLADSTONE
State : MO
Zip : 64118-4752
Country : US
Telephone Number : 816-452-2420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2008
Last Update Date : 08/05/2010

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Directions to “ JOHN REESE GRAUE II D.D.S.” Practice Location

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